Deep Neck Lift
Dr Scott J Turner is a Specialist Plastic Surgeon (FRACS) practising in Sydney with over a decade of experience specialising in facial aesthetic surgery. At his Sydney practice, Dr Turner offers advanced deep neck lift procedures for patients with complex cervical concerns that extend beyond typical age-related changes.
The neck contains multiple anatomical layers, including superficial and deep fat compartments, muscle structures, and glandular tissues. Whilst traditional neck lift surgery addresses surface-level tissue and the platysma muscle, specific individuals present with deeper anatomical characteristics—such as prominent submandibular glands, excessive subplatysmal fat, or bulky digastric muscles—that require surgical intervention beneath the platysma layer. Deep neck lift surgery employs dual-plane techniques to access and modify these deeper structures, addressing inherited anatomical features and complex tissue patterns that superficial approaches cannot adequately correct.
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Understanding Deep Neck Lift Surgery
What is Deep Neck Lift Surgery?
Deep neck lift surgery represents an advanced neck procedure that addresses anatomical structures located beneath the platysma layer. Whilst conventional neck lift techniques focus on superficial fat removal, platysma muscle tightening, and excess skin excision, the deep neck lift approach accesses the subplatysmal space to modify deeper anatomical components that contribute to neck fullness and poor jawline definition.
This surgical technique proves necessary when individuals present with inherited anatomical characteristics or deep tissue concerns that persist despite superficial intervention. The procedure may involve direct excision of subplatysmal fat deposits, partial reduction of enlarged submandibular glands, contouring of prominent digastric muscles, and modification of parotid gland tails when these structures create visible bulges along the jawline.
Anatomical Structures Addressed
The neck comprises distinct tissue layers, each contributing to the overall contour:
Superficial compartment (above the platysma muscle):
- Skin and its underlying subcutaneous fat
- The platysma muscle itself
- Preplatysmal fat deposits
Deep compartment (beneath the platysma muscle):
- Subplatysmal fat—deeper fat deposits that cannot be accessed through standard liposuction
- Submandibular salivary glands—paired glands situated beneath the jaw that may become enlarged or descend with time
- Digastric muscles—paired muscles running beneath the chin that can appear bulky in some individuals
- Parotid gland tails—extensions of the salivary glands near the angle of the jaw
Traditional neck lift addresses only the superficial compartment. Deep neck lift accesses both compartments, allowing for modification of structures that cause persistent fullness despite conventional surgical approaches.
Dual-Plane Approach
The defining characteristic of deep neck lift surgery involves the dual-plane dissection, which creates separation between tissue layers at two distinct anatomical depths:
Submandibular region (the area from the chin to the hyoid bone): Surgical dissection proceeds at both superficial and deep levels, allowing independent treatment of surface tissues and underlying structures. This permits the surgeon to address superficial fat and skin while simultaneously accessing deeper anatomical components that require modification.
Cervical region (the area below the hyoid bone): Dissection proceeds only at the deep level, maintaining attachment between skin and platysma muscle. This composite layer approach preserves natural tissue adherence in the lower neck, thereby reducing the risk of contour irregularities.
Distinction from Traditional Neck Lift
Traditional neck lift techniques effectively address the typical age-related changes that affect the superficial tissues. These procedures prove effective for individuals presenting with:
- Platysma muscle laxity and visible banding
- Excess skin accumulation
- Superficial fat deposits above the muscle layer
- Standard age-related cervical changes
Deep neck lift becomes necessary when anatomical assessment reveals:
- Substantial subplatysmal fat deposits creating persistent central fullness
- Visibly enlarged or descended submandibular glands
- Prominent digastric muscle bulk
- Inherited poor neck contour present since youth
- Persistent concerns following previous neck procedures that addressed only superficial layers
Am I a Suitable Candidate for Deep Neck Lift Surgery?
Deep neck lift surgery is suitable for individuals who present with specific anatomical characteristics that require intervention beyond superficial tissue modification. This procedure demands careful patient selection, as it involves more extensive surgical work than traditional neck lift techniques.
Physical Health Requirements
Suitable candidates demonstrate:
- Excellent overall health without conditions compromising healing or surgical safety
- Normal cardiovascular function capable of tolerating an extended anaesthesia duration
- Appropriate blood clotting function
- Stable body weight maintained for a minimum of six months
- Complete cessation of all tobacco and nicotine products for at least six weeks before and after surgery
- Realistic understanding of achievable outcomes and recovery requirements
- Psychological readiness for surgical intervention (mandatory psychological evaluation required as of July 1, 2023, under Australian regulations)
Anatomical Indications Requiring Deep Neck Lift
This surgical approach proves necessary for patients presenting:
Inherited anatomical characteristics: Some individuals possess prominent submandibular glands, bulky digastric muscles, or excessive subplatysmal fat deposits from early adulthood. These inherited features result in persistent neck fullness that is unrelated to age, weight, or lifestyle factors, necessitating surgical modification of deeper structures.
Central cervical fullness resistant to conservative measures: Persistent fullness beneath the chin that remains unchanged despite weight loss, exercise, or non-surgical treatments typically indicates deeper anatomical concerns requiring surgical reduction rather than superficial approaches.
Prominent glandular structures: Visibly enlarged submandibular glands create bulges along the inferior border of the mandible. When these structures extend noticeably below the jawline, their volume contributes to poor neck-jaw demarcation that superficial techniques cannot improve.
Suboptimal outcomes from previous neck procedures: Patients who underwent traditional neck lifts or neck liposuction with disappointing results often have underlying deep structural characteristics that were not addressed during the initial surgery. Deep neck lift can provide correction when superficial approaches prove inadequate.
Disproportionate facial-cervical aging: When facial procedures achieve satisfactory results but the neck appears disproportionately full or aged, a comprehensive deep neck lift provides the necessary correction for a harmonious facial-cervical transition.
Who May Not Be Suitable
Deep neck lift may be inappropriate for patients who:
- Present only typical age-related changes adequately addressed through traditional techniques
- Cannot commit to the required recovery period and activity restrictions
- Have medical conditions that increase surgical risk
- Are unable to cease tobacco use completely
- Maintain unrealistic expectations about achievable outcomes
- Have insufficient tissue quality or healing capacity
Individuals presenting primarily with superficial age-related changes—platysma muscle laxity, excess skin, and preplatysmal fat—typically achieve excellent results with traditional neck lift surgery and do not require the more extensive deep neck lift approach.
How is Deep Neck Lift Surgery Performed?
Deep neck lift surgery is performed under general anaesthesia in a fully accredited hospital facility. A qualified anaesthetist provides continuous monitoring throughout the procedure. Surgical duration typically extends to approximately 3 hours, varying according to the complexity of the anatomical modifications required. Dr Turner recommends overnight hospital observation following surgery, with discharge occurring the following day once initial recovery milestones are met.
Incision Placement
Incisions are strategically positioned to provide necessary surgical access whilst minimising visible scarring:
Post-auricular incisions: Placed in the natural crease behind each ear, extending along the posterior hairline
Submental incision: A horizontal incision placed in the natural submental crease beneath the chin, providing direct access to deeper cervical structures
For younger patients presenting primarily with deep structural concerns rather than significant lateral laxity, a short-scar technique using predominantly the submental approach may prove appropriate.
Step-by-Step Surgical Overview
Step 1: Superficial Dissection in the Submandibular Region
The skin is carefully elevated from the underlying structures in the area above the hyoid bone. This superficial dissection proceeds with meticulous attention to maintaining adequate subcutaneous fat thickness, preventing surface irregularities whilst providing access to the platysma muscle layer.
Step 2: Deep Dissection—Zone I (Central Submental Region)
The platysma muscle is elevated, and the subplatysmal space is entered through careful dissection. This provides direct visualisation of:
- Deep fat deposits, which are directly excised rather than removed through liposuction
- Digastric muscles, assessed for prominence and contoured when bulky
- The hyoid bone and surrounding structures
A strategic patch of subplatysmal fat is preserved at the hyoid level to maintain natural contour and prevent over-correction.
Step 3: Deep Dissection—Zone II (Body of Mandible)
The submandibular glands undergo careful assessment through the anterior approach. When these glands demonstrate enlargement or have descended below the mandibular border, partial reduction is performed. Only the portion of the gland extending below the jawline requires removal; the remainder is preserved to maintain adequate salivary function. This zone proves particularly critical for achieving enhanced jawline definition and creating a natural shadow effect beneath the mandible.
Step 4: Deep Dissection—Zone III (Angle of Mandible, When Indicated)
When anatomical assessment reveals prominent parotid gland tails creating posterior jawline fullness, the SMAS and platysma are elevated to expose the gland. A partial reduction is then performed to enhance the posterior jawline contour and create the appropriate retromandibular depth.
Step 5: Advanced Platysmaplasty
The platysma muscle undergoes sophisticated three-dimensional management:
Horizontal transection: The muscle is divided along a predetermined line below the hyoid bone, separating it into upper and lower segments. This technique provides superior correction compared to simple midline plication.
Cranial segment management: The upper segment’s medial edges are sutured together and also to the hyoid bone centrally, whilst lateral portions are suspended to the mastoid process behind the ear.
Caudal segment management: The lower segment, maintained as a composite layer with overlying skin, is suspended laterally to the mastoid.
This three-dimensional approach minimises the likelihood of band recurrence and provides more enduring results compared to conventional plication techniques.
Step 6: Superficial Fat Management
Subcutaneous fat above the platysma receives judicious contouring. Adequate padding must be maintained to prevent a skeletonised appearance, whilst jowl fat and contour irregularities are eliminated to create smooth surface transitions.
Step 7: Skin Redraping and Haemostatic Protocol
Rather than employing high-tension skin closure, which increases the risk of haematoma, a haemostatic net is applied. This specialised dressing distributes tension evenly across the tissue flap, preventing blood accumulation whilst allowing natural skin redistribution without excessive pulling. The haemostatic net remains in place for 48-72 hours.
Step 8: Wound Closure
Incisions are meticulously closed in multiple layers using fine sutures to optimise healing and minimise visible scarring. Layered closure distributes tension appropriately and promotes optimal wound healing.
Recovery and Aftercare
Recovery from deep neck lift surgery follows a predictable timeline, with initial swelling and bruising subsiding within two to three weeks. Following overnight hospital observation, patients return home with a haemostatic net in place for 48-72 hours. After this, a compression garment is worn continuously for one week, then at night for an additional one to two weeks. Sutures are removed at 5-7 days (post-auricular) and 10-14 days (submental). Most patients return to sedentary work within 2-3 weeks; however, strenuous activities, exercise, and heavy lifting should be avoided for four to six weeks. For patients who have undergone submandibular gland reduction, following a salivary-resting diet for two weeks—avoiding salty, sour, spicy, and sweet foods—helps reduce the risk of sialocele.
Final results become fully apparent between three and six months post-operatively as residual swelling completely resolves, sensation returns, and incision lines mature. Diligent adherence to post-operative instructions, including wound care protocols, activity restrictions, and sun protection measures with SPF 30 or higher once healed, remains crucial throughout recovery. Results typically remain visible for 10-15 years or longer, often exceeding the longevity of traditional neck lifts due to comprehensive structural modifications. Individual factors, including genetics, skin quality, and lifestyle choices, affect the duration of the outcome.
For detailed information about each recovery milestone, including specific care instructions and strategies to optimise your healing experience, please visit our comprehensive resource:
Recovery After Neck Lift Surgery
Risks and Complications
All surgical procedures involve inherent risks that must be thoroughly understood before proceeding with treatment. Whilst deep neck lift surgery, performed by an experienced Specialist Plastic Surgeon, typically achieves excellent outcomes, this procedure involves more extensive anatomical work than traditional neck lift and carries specific considerations. Most individuals experience expected post-operative effects including swelling, bruising, temporary numbness, tightness, and mild asymmetry, which typically resolve naturally during the healing phase. Complications specific to deep anatomical work include sialocele (salivary fluid collection occurring in approximately 2% of patients, managed with office aspiration and typically resolving within 2-4 weeks), temporary lower lip weakness (occurring in up to 4% of patients, usually resolving within 6-12 weeks), and rarely, Frey’s syndrome (gustatory sweating, treatable with injections if it occurs).
Potential complications requiring intervention may include haematoma formation (1-3% occurrence), infection (rare at <1% with prophylactic antibiotics), unfavourable scarring, prolonged altered sensation, wound healing complications (particularly in smokers), skin irregularities, unsatisfactory aesthetic results, nerve injury affecting facial movement or sensation (typically temporary, resolving within 3-6 months, with permanent injury very rare), and adverse anaesthetic reactions. Through meticulous surgical technique, comprehensive pre-operative medical assessment, surgery exclusively in accredited facilities with qualified anaesthetic support, mandatory tobacco cessation requirements, and detailed post-operative care protocols, Dr Turner minimises these risks whilst optimising patient safety and surgical outcomes.
For comprehensive information about specific risks, preventive measures, and what to expect during recovery, please visit our detailed guide on:
Risks and Complications After Neck Lift Surgery
Frequently Asked Questions
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by Dr Turner, Specialist Plastic Surgeon
